DRY NEEDLING FOR MUSCULOSKELETAL PAIN: THE “NEW” HOMEOPATHY

Samuel Hahnemann was the originator of homeopathy, a system of medical treatment devised under the principle summed up by the phrase, “like is cured by like” [Hahnemann 1796]. Drugs which when given to healthy persons cause certain specific symptoms are to be given to patients when they present to their doctors with the very same symptoms.

Hahnemann argued that only infinitesimally small doses were needed because the disease produced an abnormal sensitiveness to the given drug, provided that the correct remedy had been chosen. Another principle was that a second dose should not be given until the first had ceased to act.

When homeopathy was introduced it became popular in the 19th century and probably served a useful purpose in checking the dangerously excessive drugging, bloodletting, purging, and induced vomiting that were then prevalent [Guthrie 1945; Ackerknecht, 1968].

The dogmatism of Hahnemann’s system separated it from the mainstream of scientific development [Ackerknecht, 1968] but its survival as a cult with a relatively small following suggests that it may still, at least partially, fulfill this role [Relton et al. 2017].

The technique of “dry needling” so-called myofascial trigger points (MTrPs) [Simons et al. 1999] became popular with physical therapists during the 1990s and has remained so to this day [Dunning et al. 2014].

Remarkably, the practice is based upon the same principle as that devised by Hahnemann – “like is cured by like”.

In this case the “disease” being treated is “myofascial pain” localised to a trigger point (TrP) within voluntary muscle or other soft tissues. Those who believe that this is true postulate the existence of a lesion caused by “direct trauma or overuse” [Martín-Pintado-Zugasti et al. 2018].

The recommended therapy for such pain is to insert a needle directly into the muscle where the TrP is thought to reside. However, post-injection pain is not uncommon and is caused by “tissue injury produced by the needle and the following inflammatory reaction” [Martín-Pintado-Zugasti et al. 2018]. Animal experimental studies have been confirmatory of such an injury [Domingo et al. 2013].

Some experts consider that benefit from the technique of needling can be attributed to the destruction of the allegedly dysfunctional motor endplates producing the MTrPs as well as the related sarcomere shortening of myocytes [Dommerholt et al. 2006].

Martín-Pintado-Zugasti et al. [2018] claim that post-injection pain is “fundamentally different from the pathophysiology of the MTrP itself”. They base this opinion solely on the way in which some patients describe that pain as being different to their original pain. They did not consider the possibility that the original pain might have been wrongly attributed to the MTrP and that the tissue being needled did not in fact harbour a source of nociception [Quintner et al. 2015].

The number of needle insertions and the pain perceived during needling is positively correlated with the intensity of post-needling soreness in healthy subjects [Martín-Pintado-Zugasti et al. 2015]. This observation suggests that there is a direct relationship between the amount of tissue damage caused by the needle and the intensity of post-needling soreness.

Lewitt [1979] mentioned that a “reactivation of pain may occur several hours later or on the following day” and that this usually lasts for 1-2 days. Simons et al. [1999] recommended waiting until the soreness had resolved before repeating the procedure.

There has even been a suggestion that soreness following dry needling might be seen as a “positive sign rather than a negative experience that requires special care” [Dommerholt et al. 2015]

The conclusion seems inescapable that an actual lesion is being created in muscle through dry needling in a futile attempt to heal a muscular lesion that has never been shown to exist.

In other words, Hahnemann’s homeopathic principle lives on, but in another guise as a cultish practice that today lies well outside the mainstream theory and practice of scientific medicine.

References:

Ackerknecht EH. A Short History of Medicine. New York: The Ronald Press Company, 1968: 145.

Domingo A, Mayoral O, Monterde S, Santafé MM. Neuromuscular damage and repair after dry needling in mice. Evidence-Based Complementary and Alternative Medicine Volume 2013, Article ID 260806, 10 pages http://dx.doi.org/10.1155/2013/260806

Dommerholt J, Mayoral del Moral O, Gröbli C. Trigger point dry needling. The Journal of Manual & Manipulative Therapy. 2006; 14(4): 70–87.

Dommerholt J, Hook T, Grieve R, Layton M. A critical overview of the current myofascial pain literature – July 2015 Journal of Bodywork & Movement Therapies 2015; 19: 482-493.

Dunning J, Butts R, Mourad F, et al. Dry needling: a literature review with implications for clinical practice. Phys Ther Rev 2014; 19(4): 252-265.

Guthrie D. A History of Medicine. London: Thomas Nelson and Sons Ltd., 1945: 219-220.

Hahnemann S. Versuch über ein neues Prinzip zur Auffindung der Heilkräfte der Arzneissubstanzer nebst einigen Blicken auf die bisherigen. Journ pract Arzneykinde 1796; 2(3): 433.

Lewitt K. The needle effect in the relief of myofascial pain. Pain 1979; 6: 83-90.

Martín-Pintado-Zugasti A, Pecos-Martín D, Rodríguez-Fernández AL, et al. Ischemic compression after dry needling of a latent myofascial trigger point reduces post-needling soreness intensity and duration. PM R. 2015; 7: 1026-1034.

Martín-Pintado-Zugasti A, Mayoral del Moral O, Gerwin RD, Fernández-Carnero J. Postneedling soreness after myofascial trigger point dry needling: current status and future research. Journal of Bodywork & Movement Therapies 2018, doi: 10.1016/j.jbmt.2018.01.003.

Quintner J, Bove G, Cohen M. A critical evaluation of the “trigger point” phenomenon. Rheumatology 2015; 54: 392-399.

Relton C, Cooper K, Viksveen P, et al. Prevalence of homeopathy use by the general population worldwide: a systematic review. Homeopathy 2017;106(2):69-78. doi: 10.1016/j.homp.2017.03.002. Epub 2017 Apr 7.

Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction. The Trigger Point Manual, Vol 1. 2nd ed. Baltimore: Williams & Wilkins; 1999.

 

 

 

 

3 Comments

  1. Dr Quintner,
    Is this much like t.e.n.s. unit therapy? (Except much more dangerous and unnecessary.) In that, the intended theory is, it will “distracts” your brain from the pain you are feeling. Supposedly, Placing your attention in another, new, more painful area.
    I’m extremely wary of these sorts of thing. Staying well away from “The latest and greatest” FM treatments. (Much like the horrid new Vaccine & that test that drained some already dry and desperate people ….) While still trying the occasional Magnesium Malate supplement. Figuring that, “If it won’t fester and turn into septicemia then it probably won’t hurt.”?!
    Homeopathy has turned into a much different thing. Still benign at times and harmful but now backed by some shockingly professional people. Seemingly not interested in helping but turning a buck. I’m all for a buck, everyone has to eat. Don’t get me wrong. But there has to be a way to steer funds into the right hands! I’m open to suggestions! I have a few ears..
    Enjoying the information!
    Thank you for writing,
    Tara Augenstein, FibroSociety

    • Tara, thank you for your kind comments.

      I hope the following extract from an article that was published in the National Pain Report will answer the question – why does dry needling appear to work, at least in the short-term?

      “Is it possible for a treatment to be “accidentally” effective, despite it being based on false theoretical foundations? One explanation is that the treatments such as dry needling are rarely performed in an isolated fashion; that is, treatment is accompanied by manual therapy, home exercises, and stretching.

      The apparent effectiveness of any treatment may be erroneously attributed to the natural history of the particular problem being treated (“good days” and “bad days”), the personality and status of the therapist, and the expectation of something being done to the area in question. This gives rise to the fallacy known as post hoc ergo propter hoc (“after this therefore because of this”) when the treatment offered in fact had nothing to do with the underlying nature of the condition to which the treatment is being directed.

      A common factor shared by some manual therapies (including dry needling) is that they elicit pain at the site of their application; that is, they are potentially noxious (tissue-damaging) stimuli. If they do “work,” this similarity suggests a common mechanism of action, that of counter-irritation, or application of a competing noxious stimulus. It is not surprising that a noxious stimulus applied in the region where pain is experienced, whether or not there is local pathology present at that site, would elicit a short-lived reduction in pain intensity by recruiting those higher order brain regions responsible for anti-nociception. This phenomenon is called counter-irritation analgesia, a concept with which people who have ever hit their thumb with a hammer are familiar.”

      Here is the link to my article: http://nationalpainreport.com/to-needle-or-not-to-needle-8824782.html

      Please let me know if I have not answered your question.

      John

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